A fistful of topical events

The London Health Technology Forum has just announced the details of its Christmas evening meeting on 13th December. Star turn will be the seasonally-appropriate Andrew Nowell, CEO of Pitpatpet who has a brilliant story to tell of how an activity tracker can unlock so many revenue sources. Attendees will also unlock mince pies, courtesy of longstanding host Baker Botts, and a roundup of key digital health changes in 2017 from this editor.

NICE Health App Briefings: NICE has finally published the end result of its review of three health apps on their Guidance & Advice list. Given that digital health is so much faster moving than pharma, it is disappointing that these apps appear to be being judged to a very high level of evidence requirement.

For example Sleepio, whose evidence for  effectiveness “is based on 5 well-designed and well-reported randomised controlled trials and 1 large prospective unpublished audit” is still judged, in terms of clinical effectiveness, as “has potential to have a positive impact for adults with poor sleep compared with standard care. There is good quality evidence that Sleepio improves sleep but the effect size varies between studies, and none of the studies compared Sleepio with face-to-face cognitive behavioural therapy for insomnia (CBT‑I).”

This editor is unaware of any other app that has five good RCTs under its belt so (more…)

A few short topical items: NHS Digital, DHACA, IET, more

Rob Shaw, NHS Digital’s Deputy CEO, gave a welcome talk at EHI Live on Tuesday encouraging the NHS organisations to become “intelligent” customers. To quote “We have got to make it easier for suppliers to sell into health and social care”. Let’s hope that the message is received and acted on! Until it is, the Kent Surrey and Sussex AHSN is offering help to SMEs to make that first sales – how to book, and to get more details on the event on 23rd November go here.

DHACA’s Digital Health Safety event, in partnership with Digital Health.London on 7th November is proving extremely popular, to the point where it may be oversubscribed soon, so if you want a seat for this really important event for all digital health developers and suppliers, book now.

The IET is running a TechStyle event on the evening of 22 November entitled the world of wearables aimed at people “between 14 and 114”. For today only (1 November) they are offering a special “2 for 1” deal making the already tiny cost essentially insignificant. Book here.  Hat tip to Prof Mike Short.

Prof Short has also highlighted a recent report from Agilysis looking at the role digital technology can play in delivering the vital step change our nation’s care services need. It concluded that: 

  • Leading digital professionals say lack of digital skills biggest risk to transforming care services fit for the 21st century;
  • Lack of knowledge of digital tools is largely responsible for delays in embracing new ways of working;
  • Believe digital technology could cut costs associated with social care delivery and therefore address the number one issue affecting UK social care today;
  • Digital technology can help local authorities manage both demand (improved customer satisfaction) and supply (improves multi-agency working).

There’s a great (more…)

A random selection of what’s crossed my screen recently

One of the signs of autumn for this editor is the first email from Flusurvey. This is a brilliantly simple system that sends you an email every week asking if you have flu-like symptoms, then produces a map of the UK that gives advance warnings of epidemics. It costs nothing to join and is a great contribution to public health so why not sign up?. (They also have some exciting developments that may surface soon such as a small device that you blow into the connects to a smartphone and can tell almost immediately if you have flu’.)

Increasingly of concern to this editor, due to his deep involvement in digital health regulation, is who is working out how to regulate self-learning algorithms. It is therefore good to see the issue breaking cover in the general press with this article. For what it’s worth this editor’s view is that as technology begins to behave more like humans, albeit in a much faster, and narrow, way by learning as it goes along, perhaps an appropriately adapted use of the way human clinicians are examined, supervised and regulated, might be most appropriate. Sitting next to an AHSN CIO interested in the topic at a Kings Fund event last week, I was pleased to hear him offer precisely the same suggestion, so perhaps there is a little mileage in the idea. 

DHACA (disclosure: run by this editor) has just renewed its website after a long delay, and will be updating content over the next few weeks. First off is the events page advertising:

Our Digital health safety conference on 7th November at Cocoon Networks, London, is being run jointly with DigitalHealth.London – the MHRA has now confirmed they will present so we have almost all the relevant organisations and experts in the UK speaking at this event which should be essential attendance for all involved with the development and use of digital health & care. Attendance has increased substantially in the past few days so do book soon to be sure of securing a place. Much more, including an almost-finalised agenda, is here.

DHACA Day XV – we are back to our usual location at the Digital Catapult Centre on 10th January where are building an agenda of some extremely interesting speakers. To check out the agenda development and to book in advance, go here.

(more…)

Regulation, safety and sustainable development: three short important updates

Erik Vollebregt has just released a blog that should be read by anyone with a medical device or whose technology is likely to be classified as a medical device under the new Medical Devices Regulation (MDR – Regulation 2017/745/EU) which replaces the MDD in early 2020. It makes scary reading as to what will need doing to comply with the new regulations as approval under the MDD will no longer apply (no ‘grandfathering’). MedTech Europe has helpfully produced a flowchart describing the necessary steps. Advice from official sources given to this editor is that, as the MDR already applies in the EU, its continued application in the UK after Brexit is not in serious doubt, so UK companies should not delay.

The Digital Health & Care Alliance (disclosure; that this editor manages) and DigitalHealth.London are jointly running a digital health safety conference on 7th November. Key players in the UK are on the agenda (including the CQC, MHRA, HSIB, NHS Digital/England, Datix, Vitalpac etc.). This is a topic that requires the attention of all developers and providers of digital health, as new technology, being unfamiliar, is inherently risky. It is therefore really key for everyone involved to share experiences, understand the risks and carefully plan avoidance and mitigation.  The draft agenda and booking details are here (there is a small charge for lunch).

For those who have doubts about the benefits that mobile communications can bring at times, a read of the GSMA’s 2017 report on mobile’s contribution to the UN’s sustainable development goals will fill you full of optimism of what technology can do, for health and many other aspects of life. Beautifully presented and full of interesting facts: recommended! (If you’ve not enough time, the summary is here.) Hat tip to Prof Mike Short. 

Free individual advice and guidance to SMEs wanting to sell to the NHS

Here is your opportunity as an SME to get advice on selling to the NHS. Specfically, DHACA and Kent Surrey & Sussex AHSN have joined forces to help you to prepare a more compelling and comprehensive value proposition as part of your market access strategy. (SMEs don’t need either to be in the KSS AHSN catchment areas, or members of DHACA, although the latter is free to join and has lots of useful digital health resources, so why wouldn’t you?) 

There will be two sessions, both of which you should be able to attend if you apply. These will be held at the Royal Society of Medicine (close to Oxford St and Bond St tubes). That on 20th July will be about 90 minutes. In that time you will hear and be able to discuss:

  • How current NHS finances and cash flow may impact on your service/product uptake
  • How to improve your value proposition for NHS audiences

This will help you prepare for the second stage, on 27th July, which will be an individual Innovation Surgery. These will last 1 hour and cover aspects from the market access briefing. They will be specific to your product as well as covering the technical and market potential of your product/service.

More details and how to apply are available in the DHACA Briefing and Surgery Flyer

Note that although the flyer says you need to email vivienne.gray3@nhs.net by the end of Thursday 6th July to apply, Vivienne will be happy to accept late applications, though do please get them in soon!

(Disclosure: this editor is Managing Director of DHACA)

 

Calling all digital health people in the North of the UK (and the South)

Sadly the DHACA Day in Leeds on 27th April had to be cancelled because of competing events on that day – readers are reminded of the next DHACA Day now in London on 21st June – agenda still to be set.

Elsewhere, Nesta has updated its European Digital City Index, showing the position at the end of 2016
of the top 50 cities in Europe for start-ups. Not digital health-specific though very interesting, nevertheless. TechCity have produced a more detailed website exploring why the UK is the Tech Nation of Europe, which is excellently animated. Though with little mention of digital health it is nevertheless an excellent read, and resource…and something to make those of us who are involved in the UK digital scene proud of our achievements. And if you are a supplier looking for opportunities to capitalise on the UK’s standing, what better than to attend Healthcare UK and NHS Digital’s International Digital Health Opportunities event in London on 25th April?

If you are still feeling international though less interested in exporting, perhaps you might like to attend (more…)

Debate on Care Quality Commission’s position on online prescription services on Radio 4’s TODAY (UK)

Friday’s BBC Radio 4 TODAY breakfast show has two segments discussing the Care Quality Commission‘s public warning on online prescription services and potential danger to patients. The first is a short interview of Jane Mordue, Chair of Healthwatch England and independent member of the CQC (at 00:36:33-00:39:00). The second, longer segment at 02:37:00 going to 02:46:30 features our own Editor Charles Lowe, in his position as Managing Director of the Digital Health and Care Alliance (DHACA), debating with Sandra Gidley, Chair of the Royal Pharmaceutical Society (RPS) English Board. The position of the RPS is that a face-to-face appointment is far preferable to an online service, whereas Mr Lowe maintains that delays in seeing one’s GP creates a need for services where a patient can see a doctor online and receive a prescription if necessary. The quick response allays anxiety in the patient and provides care quickly. Both agreed that a tightening of guidelines is needed, especially in the incorrect prescribing of antibiotics, and that there is no communication between patient records. Mr Lowe notes that GPs have always been comfortable with a telephonic consultation but are far less so with telemedicine consults via Skype. Here’s the BBC Radio 4 link available till end of March.

In the US with 24/7/365 telemedicine services such as Teladoc, MDLive and American Well, there is a similar problem with patient records in many cases except for history that the patient gives, but this is an across the board problem as the US does not have a centralized system. The prescribing problem is less about antibiotics, though MRSA/MSSA resistant superbugs are a great concern. According to Jeff Nadler, CTO of Teladoc during his #RISE2017 presentation here in NY attended by this Editor, Teladoc has a 91 to 94 percent resolution rate on patient medical issues. Of that 9 percent unresolved, 4 percent are referred, 2 percent are ‘out of scope’, 1 percent go to ER/ED–and 2 percent of patients are ‘seeking meds only’, generally for painkillers. Teladoc’s model is B2B2C, which is that patients access the service through their health plan, health system, or employer.

British Journal of Cardiology (BJC) Digital Healthcare Forum’s inaugural meeting

28 April, 9:30am-5pm, Royal College of Obstetricians and Gynaecologists, London 

Henry Purcell of the BJC was kind enough to post us with information on the first-ever BJC Digital Healthcare Forum. Organized by the BJC in association with the NHS, the Digital Health and Care Alliance (DHACA), and the Telehealth Quality Group, it is a novel ‘hands on’ meeting to assess if digital medicine can fill gaps in healthcare provision throughout the NHS. It is also in response to the massive pressures which winter has wrought on NHS health and social services. The Forum was designed by clinicians and leaders in healthcare informatics for UK commissioners, doctors and other HCPs involved in the management of long-term conditions (cardiovascular, obstructive pulmonary disease, diabetes etc.), as well as those engaged in health informatics, IT, and Trust CEOs. Speakers include Dr Malcolm Fisk of De Montfort University, our own Charles Lowe of DHACA, Professor Tony Young, National Clinical Director for Innovation (NHS England) and many more experts in digital health and care. For the latest information and to register, see the event website or the attached PDF.

When is an app not an app? (When it’s a conundrum)

It all started so simply. In DHACA under the leadership of Rob Turpin (BSI) we produced the definitive guide to app regulation in the UK. Sure it was 44 pages long (and will shortly need updating) however we all knew that an app was standalone software and that none other than MEDDEV 2.1/6, the ultimate definitive guide to when an app is a medical device defined software as:

…a set of instructions that processes input data and creates output data.

However doubts began to creep into this editor’s mind when he heard that app developers in the US were avoiding (US/FDA) medical device classification as that would rule them out as service providers, which can reduce future  reimbursement benefits – as we quoted Ralph-Gordon Jahns of research2guidance in 2014 “profitable developers… rely on service sales as their primary source of revenue.”

Things got more complicated when it emerged at the UK Health Show this autumn that PHE was considering listing digital GP services as (more…)

Accelerated Access Review published – well worth a read

The Accelerated Access Review is published today. Readers with long memories will recall that it kicked off in the Spring of 2015 aimed at accelerating the uptake of innovation in to the NHS. It had three technical streams – pharma, medtech & digital health, plus a patient stream. This editor, as Managing Director of DHACA, was the digital health champion.

DHACA members were heavily engaged in the consultation, so it is gratifying to see that all DHACA recommendations were accepted. Most important were recommendations that:

  • NICE broaden its reach to include more medtech & digital health recommendations, and consider other means of funding;
  • there be closer alignment of regulatory and NICE data requirements and processes (currently, there can be duplication);
  • a strategic commercial unit is established in the NHS;
  • a small amount of funding is offered to support the commercialisation of disruptive innovative technologies that significantly change care pathways;
  • products not referred to NICE should be assessed only once by NHSE;
  • the route for digital products should build on the “Paperless 2020” simplified app assessment process;
  • the Crown Commercial Service, in partnership with NHS Digital, NHS England, the Department of Health and other system and technology partners, should consider how best to develop an accessible, simple and swift competitive process for procuring digital products from SMEs;
  • NHS England, working with NHS Digital, should develop a generic framework for app prescription.

When implemented, these and all the other recommendations in the report will go a long way to (more…)

A clutch of interesting digital health events

DHACA is holding its tenth DHACA Day on October 6th, three minutes’ walk from Leeds station. We have a wide array of fascinating speakers, with a keynote by Bethany Gildersleve, Head of Operations at NHS Digital. Membership of DHACA is free, though we have to make a small charge for lunch. For more details, and to book, go here.

The Royal Society of Medicine (RSM) is holding an event on Point-of-Care-Testing, a technology that enables radical improvement to care pathways that improve patient outcomes and can dramatically reduce costs. Keynote will be Prof Chris Price, Visiting Professor in Clinical Biochemistry, University of Oxford, widely recognised as the leading authority in the world on the topic. For more details, and to book, go here.

The RSM has an earlybird (ie even lower cost) offering for our mHealth app conference on April 4th 2017 – these rates will last until 29th November. For more details, and to book for this event, now in its fifth year & which has serially sold out, go here.

The RSM is also has another long-running and regularly very well-attended event on 28th February entitled Recent Developments in Digital Health. Last February’s presentation by Mustafa Suleyman, co-founder of Google DeepMind, is still being talked about. Details and booking here.

Finally the London Health Technology Forum has its first Autumn meeting on 20th October, covering the true story of how a start-up made its first sale to the NHS from both the point of view of the seller and from that of the NHS buyer. Attendance is completely free – book here. (While you’re at it, you may want to book for the Christmas Pitch too, as it’s certain to be fully booked before it takes place on 24th November.)

Disclosure: all the above have had some involvement, to a greater or lesser extent, from this editor.

Asthma UK recruiting for a new digital health role – interested?

Asthma UK has decided on a most exciting initiative to educate the tech industry on how they can best support the condition with new technology. Spearheading this activity will be this new role which is also expected to bring expertise to developing those digital health solutions: part stakeholder management, part UX designer.

If you want to know more, Joe Clift, Senior Policy Officer at Asthma UK, who is working alongside this new role, will be talking at the next DHACA Day in Leeds on October 6th (book here).

Details of the application are here. Applications close on 9th October.

Catch-up: what you may have missed whilst on holiday

This was the month when the UK Press seemingly finally woke up to the existence of STPs (Sustainability & Transformation Plans). This article by Derek du Preez and this in Digital Health are two one of a few that pick out the hope that digital health can help with making the NHS more sustainable. Sadly the headlines were grabbed with concern over closing hospital beds, which politicians in the UK still seem to consider to be a Bad Thing. Even though hospital beds have been reduced in most European countries over recent years, and those such as Denmark now trumpet reductions in hospital beds as progress, we have still to break the connection in people’s minds in the UK that beds are a good surrogate for health service delivery volume, (even though when pressed no individual seems keen to spend longer in hospital than absolutely necessary, or would prefer a treatment as an inpatient over treatment as an outpatient.)

Though not directly connected, the NHS offered over £100m to acute care trusts for “global digital excellence” – in line with the previous comments, perhaps the money could alternatively be spent on the UK building on its excellent primary care IT with the specific intention of moving more treatment out of hospitals…and follow that up with a proposal to put the hospital that is judged to be the least “globally digitally excellent” (more…)

Digital health dates for Autumn 2016

Fancy a startup in Barcelona? Look no further than the NUMA Barcelona Accelerator. Note entries needed by 25th September.

The Biomedical Catalyst 2016 early stage award competition requires registrations by 7th September, applications in by 14th September.

The European Commission has opened a public consultation on the safety of apps and other non-embedded software as part of an effort to ensure a high level of health, safety and consumer protection. Be sure to respond by closing date of 14th September.

Baker Botts, the international firm of lawyers specialising in intellectual property has very kindly agreed to continue to support the London Health Technology Forum which has now agreed three evening events this autumn, on 15th September, 20th October & 24th November. The programmes are (more…)

Guest blog: Health and Social Care Innovation – are we really learning our lessons?

Hazel Harper, Programme Manager, Health & Care, at Innovate UK has kindly offered readers this guest blog (which is also available on the Innovate UK website).

Delivering Assisted Living Lifestyles at Scale (dallas) is the largest innovation programme in Health and Care to date. With an ambitious target of touching the lives of over 160,000 people, just exactly what can we learn from this ambitious programme?

 It was no mean feat. With no blueprint combined with delivering business as usual and only 3 years to deliver there are plenty of lessons but the question is how many of them will we really learn or will our incessant need to do things our way or no way remain the longest running barrier to progress we’ve known in this space?

lessons learnt

Insight in to some of the lessons learnt (in no particular order)

(more…)

Sleepio and Alivecor enhance digital health credibility

This has proved to be a great week for digital health credibility.

Firstly Sleepio picked up two honours – one was scoring the highest mark on the first Ranked Health output. The second was getting the American College of Physicians to come out and say that CBT-I should be the treatment of choice for insomnia (above hypnotics).

Meanwhile a study has shown that “A Smart Phone-based ECG Recorder Is Non-inferior to an Ambulatory Event Monitor for Diagnosis of Palpitations”. In layman’s language, the Alivecor/Kardia smartphone peripheral and app are as good as the awkward to wear & cumbersome Holter monitor.

Well done both!

Those who have heard Dr Sophie Bostok, the indefatigable Sleepio Sleep Evangelist, explain (more…)